GREEN LANE HOSPITAL EXPERIENCE WITH MITRAL-VALVE REPAIR FOR PROLAPSE - ADVERSE OUTCOMES FOR HIGHLY SYMPTOMATIC PATIENTS

Background and aims of the study: Valve repair, where suitable, is the preferred option in patients who require mitral surgery. A number of studies have shown excellent long-term results, but most were undertak en in tertiary referral centers with a high throughput of patients. Me thods: We present our experience in 60 patients, aged 60 +/- 14 years, undergoing repair between 1984 and 1993. Most patients (83%) were in New York Heart Association (NYHA) class II or III at the time of surge ry; 27% had concomitant ischemic heart disease. Almost all (98%) had p osterior leaflet repair and 18% had anterior leaflet repair. Eight sur geons each performed a mean of 7.5 operations during this period. Resu lts: The 30-day mortality rate was 3.3%. There were seven late deaths. Five patients underwent reoperation for mitral regurgitation (two ear ly, three late). At six years, 60% of patients were alive, or free of stroke or reoperation. Late follow up was obtained in 45 of 47 survivi ng patients: 95% were in NYHA class I or II; one-third were on anticoa gulants for atrial fibrillation; 90% had mild (or less) mitral regurgi tation on echocardiography. Conclusions: These data show that most pat ients have a very good outcome from valve repair surgery and encourage the trend towards operating earlier in the course of the disease. Adv erse outcomes occurred mainly in patients who were highly symptomatic at the time of surgery. The high proportion of patients on postoperati ve anticoagulants underscores the importance of operating before atria l fibrillation becomes permanent.